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In our series of recent posts, we’ve focused on the importance of early detection of modifiable risk factors associated with cognitive impairment. Conditions such as depression and anxiety are patient conditions that the physician can address with evidence-based treatments

A careful review of the overlap by Starkstein et al., however, highlights important factors central to anxiety:5 Excessive worry/anxiety that is difficult to control Presence of anxiety symptoms is additionally associated with diminished quality of life and activities of daily living (ADLs) when compared to dementia without anxiety. The relationship between benzodiazepine exposure and subsequent development of dementia is unclear and controversial, with the link suggested and rebutted in a series of publications.4 Nevertheless, the risk profile of benzodiazepines increasingly is leading practitioners to use antidepressants as first-line pharmacologic treatment of anxiety, which as noted has significant overlap with depression. With many antidepressants having additional indications for anxiety, physicians can choose agents based on side effect profiles, capacity to address insomnia, and, more recently, potential cognitive benefits.3 Psychotherapies, particularly those with supportive and relaxation components, are important treatment options during the early stages of cognitive impairment.1 How to assess cognition and behavioral healthAssessment for current behavioral health conditions is an essential addition to the workup of cognitive impairment in the elderly. BrainCheck can assist the practitioner in assessing current cognition and behavioral health; re-assessment of cognition can play an important role in the evaluation of response to treatment, particularly improvement in mental function in response to de-prescribing.

The benefits of actively assessing and treating anxiety in elderly individuals with dementiaIn our last blog post, we reviewed the relationship between depression and dementia. In this post, we will focus on another common behavioral health condition — anxiety

The merits of actively assessing and treating depression in elderly individuals with cognitive impairmentIt’s easy to assume that learning of a dementia diagnosis is inherently depressing. Evidence of high levels of depressive symptoms prior to diagnosis of cognitive impairment was associated with the rate and severity of cognitive decline. Neuropsychological assessment of depression in dementia in older adultsThe presence of depressive symptoms in the context of mild cognitive impairment (MCI) or subjective complaints of memory loss deserves formal assessment and vigorous treatment, providing an opportunity to alter the course of cognitive decline as well as impacting the quality of life and overall health. After establishing a baseline, use of BrainCheck and mood screeners can help the physician evaluate response to treatment with antidepressants and/or psychotherapy and can be an essential tool in determining a differential diagnosis of depression vs. early-stage dementia.